Archived: Reside at Southwood

Updated 14 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 1, 4, 8 and 11 May 2018. The visit on 1 May 2018 was unannounced, the remaining visits were planned with short notice.

The inspection was carried out by an adult social care inspector and an assistant inspector

The inspection was prompted because we received information of concern and safeguarding alerts from the local authority.

We did not have access to information from an up to date Provider Information Return (PIR), because the inspection was brought forwards from the planned date. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed all the other information we held about the service, including previous inspection reports and any notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law. We also contacted the local authority commissioners and safeguarding teams to establish their views of the service.

We met and spoke with 10 of the people living in the home. Because a large proportion of the people were living with dementia, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with three visiting relatives or friends, the registered provider, new manager, nine members of staff and four visiting health or social care professionals.

We observed how people were supported and looked at 14 people’s care and support records and records and documents about how the service was managed. This included six staffing records, audits, meeting minutes, training records, maintenance records and quality assurance records.

Updated 14 July 2018

This comprehensive inspection took place on 1, 4, 8 and 11 May 2018. The first day of the inspection was unannounced. We gave the provider short notice of our visits on the other days so that the manager and staff would be available to speak with us, and appropriate records would be available.

Reside at Southwood is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to accommodate a maximum of 38 people who require support with personal care. There were 24 people living in the home at the start of our inspection.

The service comprises three individual houses which have been linked together to form one building. Accommodation is provided in individual bedrooms on the ground, first and second floors. Some rooms have ensuite facilities. There are two lounges and a dining room on the ground floor. The home specialises in providing care to people living with dementia.

The service was led by a new manager who was not registered with the commission but confirmed that they had submitted an application to become registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection was brought forward from the planned date because we received information of concern and safeguarding alerts from the local authority. At our last inspection in January 2018, we found shortfalls in a number of areas and the service was rated Inadequate and placed in special measures. At that time we found breaches of the regulations relating to the way people received care and treatment, that people's consent was not always properly obtained and people were not always treated with dignity and respect, the management and administration of medicines, the management of risks to people, premises and equipment that was not safe to use, the recruitment, training and supervision of staff, the service did not act in accordance with the Mental Capacity Act 2005, quality monitoring systems were not effective and record keeping required improvement.

At the last inspection there were nine breaches of the regulations. At this inspection action had been taken to comply with one of the regulations but the other eight breaches of regulations were repeated.

The feedback we received from people and their relatives and visitors was that staff were kind and most people were happy living at Reside at Southwood. We observed that not all of the staff made meaningful connections with people and therefore not everyone received person centred care. This was because many of the staff focussed on completing a task and then moving to the next task.

At the last inspection, systems and procedures to ensure people were safe in the event of an emergency were not effective. At this inspection we found that work was underway to ensure this was addressed but not all staff had received training in the action to take in the event of an emergency. Also, they had not taken part in a fire drill to practice their learning.

We raised concerns about the number of staff on duty at night at the last inspection and at this inspection found that this had been addressed. However, actions to ensure that staff had the necessary skills, training and competence to care for people and meet their needs had not been completed. Failure to complete thorough moving and handling training for staff had continued to place people and staff at continued risk of injury.

We again found that systems to manage the administration of medicines were not robust and meant that people may not always be receiving their medicines as prescribed. We could also not be sure that people always received all of the food and fluids they needed to maintain good health.

During the inspection in January 2018 and again at this inspection, we found that systems to manage risk and ensure people were cared for in a safe way were ineffective. Risk assessments were not always fully completed or regularly reviewed. Some risks had not been identified and therefore no action had been taken to reduce or manage the risk. This meant that people’s safety and well-being was not always protected.

At the last inspection we found that people did not always have their rights protected because the service did not operate in accordance with the Mental Capacity Act. At this inspection we found that no action had been taken to address this. This meant that some people may have been illegally deprived of their liberty and not had their human rights respected.

The service had again failed to ensure that care planning systems were robust, detailed and up to date. Some assessments had not recognised specific care needs and no care plans had been created for these. Some people’s needs had changed and care plans had not been reviewed and amended. This meant that staff may not be aware of people’s needs and therefore people may not receive the care they required. For example, there are a number of different types of dementia that will affect people in different ways such as causing auditory or visual hallucinations. There was no assessment of people’s needs and indicators that they may be experiencing this. Other people had been diagnosed with serious mental health conditions, Parkinson’s disease and epilepsy. Again, there was no information or guidance for staff in care plans about these matters.

During the inspection in January 2018 we found that management arrangements and systems did not ensure that the service was well-led. Quality monitoring systems were not used effectively and record keeping was poor, as records were out of date and contained errors and omissions. At this inspection staff reported that they had confidence in the new manager. However, we found that management and oversight systems, quality monitoring and record keeping continued to be ineffective.

Recruitment procedures had been reviewed and action had been taken to ensure that any new staff employed to work at the service were suitable to work with vulnerable people.

Following our inspection, the registered provider told us that they planned to close the service. All of the people living in the home had moved out by 27 June 2018.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.